MEDICARE: DR. HOLLIS T ROGERS III M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208C00000X	Colon & Rectal Surgery Physician	MD.025523	LA
2	208C00000X	Colon & Rectal Surgery Physician	E4943	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	5N621	OTHER	AR	BCBS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1538125638
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HOLLIS T ROGERS III M.D.

Provider Business Mailing Address
First Line	:	3232 N NORTHHILLS BLVD
Second Line	:
City	:	FAYETTEVILLE
State	:	AR
Zip	:	72703-4005
Country	:	US
Telephone Number	:	479-587-1700
Fax Number	:	479-587-1366

Provider Business Practice Location Address
First Line	:	3901 PARKWAY CIR
Second Line	:
City	:	SPRINGDALE
State	:	AR
Zip	:	72762-6362
Country	:	US
Telephone Number	:	479-587-1700
Fax Number	:	479-587-1366

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/26/2006
Last Update Date	:	01/31/2024

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